1. CME in 2012

2. Baylor Health Care System Serving all people through exemplary health care, education, research and community service.

3. A. Webb Roberts Center The mission of the A. Webb Roberts Center for Continuing Medical Education of Baylor Health Care System, Dallas is to provide lifelong learning for physicians based on documented needs and practice gaps, utilizing evidence-based medicine fundamentals to change clinical competence and improve physician performance with the ultimate goal of sustaining and improving the quality of patient care.

4. The AWRC mission supports the BHCS mission through the designation of credit for exemplary continuing medical education. The AWRC staff supports the mission of BHCS affiliates and departments through the designation of credit for exemplary continuing medical education.

5. Quick Glance o AWRC is an Accredited Provider for the Accreditation Council for Continuing Medical Education. o AWRC must meet the accreditation requirements set forth by the ACCME for every single hour of education designated for credit.

6. Go Us! In July 2012, the A. Webb Roberts Center was awarded Accreditation with Commendation for a 6-year period. This shouts volumes about the quality of our CME Program. And your support of and commitment to Baylor CME.

7. How to Meet the ACCME Requirements? o AWRC staff has implemented a specific and detailed planning process. o AWRC planning process follows ACCME criteria o Each and every Regularly Scheduled Series must follow the AWRC planning process

8. AWRC Planning Process o Ensures Regularly Scheduled Series meet the definition of continuing medical education o Ensures RSS educational content is independent of commercial influence, objective, scientifically rigorous and therapeutically balanced o Ensures RSS educational intervention is designed to change clinical competence and/or professional practice

9. AWRC Planning Process Overview Completing the AWRC Planning Worksheet: o Identify a problem that exists in the physician practice and/or hospital o Identify who is in the best position to fix the problem o Identify why the problem exists o Identify the Series’ intended outcome/expected result o Identify how the RSS will fix the problem o Evaluate whether the RSS was effective in reaching the expected result o Use analysis of data to plan/change the RSS

10. AWRC Planning Process Step 1 Identify a problem that exists in the physician practice and/or hospital o Answer the question: What is the problem? This answer is the professional practice gap. The difference between current and optimal practice What the educational intervention will address The basis for the content of the education McDonald’s EXAMPLE: It is Friday afternoon, you are in the drive through at McDonald’s with 10 minutes until time to pick your child up from school. You place your two- item order. You repeat your order - once, twice, three times. The display screen used to verify the accuracy of your order is still not correct. What is the problem? Accuracy of your order. Time spent in the drive through.

11. AWRC Planning Process Step 1 – Clinical Example Our Planning Committee has determined that providers caring for children lack information on recent updates in asthma guidelines, have inadequate skills in recognizing when to refer children with chronic otitis, and have inadequate understanding of emerging trends in pediatric vaccination practices by parents. What is the problem? Lack information on recent updates in asthma guidelines Inadequate skills in recognizing when to refer children with chronic otitis media Inadequate understanding of emerging trends in pediatric vaccination practices by parents

12. AWRC Planning Process Step 2 Identify who is in the best position to fix the problem o Answer the question: What group of physicians can best fix the problem? This answer is the target audience. The specialty or specialties The scope of the physician practice – clinical, administrative, research Other healthcare professionals McDonald’s EXAMPLE: Who is in the best position to fix the problem? Management

13. AWRC Planning Process Step 2 – Clinical Example Who is in the best position to fix the problem? Physicians Pediatricians Clinical

14. AWRC Planning Process Step 3 Identify why the problem exists o Answer the question: Why does the problem exist? This answer is the educational need. Does the problem exist because of a lack of knowledge? Does the problem exist because of a lack of clinical competence? (Strategy to apply knowledge.) Does the problem exist because of a lack of skill to apply strategies? (Professional performance) Addressing why the problem exists will fix the problem McDonald’s EXAMPLE: Why does the problem exist? Lack of training tools (competence) Lack of workforce management knowledge to appropriately assign workers based on skill set Lack of workforce management strategy (competence) to appropriately assign the adequate number of workers to match volume of drive through business

15. AWRC Planning Process Step 3 – Clinical Example Why does the problem exist? Lack of knowledge about recent updates in asthma guidelines (competence) Inability to recognize when to refer children with chronic otitis media (competence) Lack of knowledge about the emerging trends in pediatric vaccination practices by parents

16. AWRC Planning Process Step 4 Identify the expected result o Answer the question: What do we want to change? This answer is the expected result. Do we want to change clinical competence? Do we want to change professional performance? Do we want to impact patient outcomes? Or some combination of the three? TIP: The expected result must be measureable. McDonald’s EXAMPLE: What do we want to change? Implement effective training tools (competence) Increase workforce management knowledge to better match workers’ skill set to duties Apply workforce strategies (competence) to adequately staff based on business volume Increased knowledge and competence will favorably impact the accuracy of orders and efficiency of the drive through.

17. AWRC Planning Process Step 4 – Clinical Example. What do we want to change? Increase knowledge about recent updates in asthma guidelines Ability to recognize when to refer children with chronic otitis media (competence) Implement strategies to apply the updated asthma guidelines in the management of their patients (competence) Increased knowledge and competence will favorably impact the safe, effective and timely administration of vaccines.

18. AWRC Planning Process Step 5 Identify how the educational intervention will fix the problem o Answer the question: What information should the education include to fix the problem? This answer is the content. Written as learning objectives. New information as a result of an advance Existing information that is a problem for the target audience Strategies, proven protocols to apply best care Ways to overcome barriers to application of strategies McDonald’s EXAMPLE: What content will get the expected result? Detailed steps to follow for training workers Guidelines for matching workers’ skills to duties Outline of which duties require which skills Data needed to adequately schedule workers for appropriate workforce management

19. AWRC Planning Process Step 5 – Clinical Example What content will get the expected result? Physicians will be informed about the newest updates in national asthma guidelines Physicians will determine strategies/proven protocols to apply the newest updates in national asthma guidelines to the management of their patients with asthma Physicians will be able to determine when to refer children with chronic otitis media.

20. AWRC Planning Process Step 6 Evaluate whether the educational intervention was effective in reaching the expected result o Answer the question: How can one measure if education fixed the problem? This answer is the educational effectiveness. A tool to measure the changes in competence, performance or patient outcomes that were expected The analysis of this data used to determine if the education was effective in changing learner clinical competence or professional performance McDonald’s EXAMPLE: How to know if the problem was fixed? Measure volume of return customers Measure number of orders that had to be corrected Measure amount of time each car spends in the drive through

21. AWRC Planning Process Step 6 – Clinical Example. How do we measure if the education fixed the problem? Survey the learners with questions such as: What are the newest updates in national asthma guidelines? What strategies will you use to apply the newest updates in national asthma guidelines to the management of your patients with asthma? How will you determine when to refer children with chronic otitis media?

22. Submission Process Regularly Scheduled Series For each RSS: o Identify a physician course director (Individual responsible for educational content) o Complete and submit the AWRC Planning Worksheet o Include all requested supporting documents o Gather and submit compliance documentation o Submit promotional material for approval For some Sessions: o Complete and submit Session Documentation form o Include supporting documents o Include compliance documentation

23. Submission Process o The AWRC planning process applies to every single RSS. o The AWRC allows for a 3-year approval term for each RSS, unless: o Intended outcome/expected result changes o Target audience changes o Practice gap closed o AWRC is in a new accreditation period. o So all things are made new.

24. RSS Approval Period January 2013 – December 2015 What does this mean? o Current RSSs expire at the end of December 2012 What do you do? o Evaluate the benefit of existing RSSs o Follow AWRC planning process for each RSS you wish to renew

25. Compliance Documentation All Persons in a Position to Control Content Determine which persons are in a position to control content (i.e., Course Director, Chief of Service, All physicians on staff) o Provide a CV o Complete Content Validation & Disclosure of Relevant Financial Relationships Form Disclose any relevant financial relationship Agree to prepare content that is: Scientifically rigorous Independent of commercial influence Therapeutically balanced Patient care recommendations – based on evidence accepted within the medical profession, based on best available evidence as justification for recommendation and scientific research referred to conforms to generally accepted experimental design Agree to disclose any reference to off-label and/or unapproved use of drug/device

26. Compliance Documentation Relevant Financial Relationships What to disclose? o Financial relationship with any proprietary entity Proprietary entity – any commercial company producing health care goods or services o Financial relationship of self and spouse during the previous 12 months o Financial relationship related to the content of the education Why disclose? o Openly identify any relevant financial relationship that could potentially represent a conflict of interest o Allow the learner to form own judgment about the balance of the content with full knowledge of existing relevant financial relationships

27. Compliance Documentation Relevant Financial Relationships Resolving the Potential Conflict of Interest If a relevant financial relationship is disclosed, the potential for a conflict of interest must be resolved prior to the beginning of the educational intervention. How to resolve? o Course Director contact person to discuss Content requirements Confirm content is not commercially biased o Person with relevant financial relationship must: Agree to specific content requirements Sign form in attestation of agreement

28. Compliance Documentation Declaration of Relevant Financial Relationships The relevant financial relationships disclosed by persons in a position to control content must be declared to the participants prior to the beginning of the educational intervention. What to declare? Name of individual Nature of relevant financial relationship (consultant, speaker, research) What was received (grant, honorarium) Name of proprietary interest Application of resolution of conflict of interest process, if applicable How to declare? o Verbal format Must be documented Must be signed o Written format Evidence of declaration must be included in Session documentation.

29. Promotional Material All promotional and educational material must be approved by the AWRC prior to distribution. Promotional material is any mechanism used for audience generation (email notices, fax notices, posters, etc.). Educational material is any information given to the learner (handouts, program services). What is required on the promotional material? Global intended outcome and/or session-specific learning objectives AMA credit designation statement ACCME accreditation statement

30. In the Event of the Following Phone the AWRC Staff o Medical educational grant funding Totally acceptable – phone the AWRC staff o Exhibitors Totally acceptable – phone the AWRC staff o Payment to the course director and/or faculty May be acceptable – phone the AWRC staff

31. For the Recording of Credit RSS Session Packet The AWRC must have the following for every single session: CVs of all persons in a position to control content Signed disclosure forms from all persons in a position to control content Signed Resolution of Conflict of Interest form, if applicable Evidence of declaration of disclosed information (and resolution of conflict of interest, if applicable) Promotional material – copy of all formats Handout material Evaluation forms – subjective comments summarized Excel spreadsheet of attendees claiming credit

32. Extra Guidance on Planning You do not need prepare needs assessments, gap statements, and learning objectives for each RSS session as part of the Planning Worksheet submitted at the beginning of the approval period. You do need to Communicate the major approaches you will use to define needs, The most critical practice gaps you plan to address over the course of the Series, The Series’ broad/global learning objectives, The Series’ broad/global expected result.

33. Another Example Source of Practice Gap & Underlying Need The Activity Director, Dr. Hughes, regularly confers with Surgery faculty and trainees to review previous RSS evaluative data, new developments/advances, and QA data. The analysis of this data is used to develop the curriculum for the RSS. Practice Gap Statement This RSS seeks to close professional practice gaps in surgical knowledge and competence. Overall learning objectives might include the following As a result of completing this RSS Session, participants will be better able to: Manage common complications of surgical therapy.

34. And Another Example Source of Practice Gap & Underlying Need The Education Director and QI Committee review recent examples of clinical adverse events and “near misses” to select cases for discussion. Practice Gap Statement This RSS seeks to address professional practice gaps in team communication and professional competence that arise in the management of hospitalized patients. Overall learning objectives might include the following As a result of completing this RSS Session, participants will be better able to: Identify and respond to adverse events.

35. And Just One More Example Source of Practice Gap & Underlying Need Professionals who care for cancer patients are confronted with the complexity of the health condition and the variety of treatments available. Educational needs include those identified in AJCC staging guidelines, NCCN treatment guidelines, and WHO practice guidelines. Practice Gap Statement During Cancer Conference, participants will receive updated information that will address knowledge gaps in recommended standards of care and practice gaps in the treatment of cancer patients. Overall learning objectives might include the following As a result of completing this RSS Session, participants will be better able to: Utilize recommendations from current clinical guidelines.

36. M&M Case Conferences For M&M Conference and Tumor Boards, Identifying the professional practice gaps and underlying educational need is evident within each case. For example, for M&M, in the presence of the death of a patient or the medical complications of a critical patient, the health care team gathers to discuss what they might have done to prevent this unexpected or undesirable outcome; and, that in itself is the determination of the professional practice gap. The underlying need for knowledge and/or competence and content for the discussion is derived from the identified practice gap (i.e., the cause of the adverse event). So, when the discussants state, “XYZ is why we had a problem”, the professional practice gap that led to the unexpected outcome is identified. The discussants continue with “Why was that? Why did we do XYZ?” This is the identification of the need for knowledge or competence or the understanding of a performance problem that underlies XYZ. The remainder of the discussion (i.e., the content) follows XYZ and the answer to why XYZ happened/was done. Further, the discussion may include the realization of the need for a Grand Rounds on the pathophysiology of XYZ; the identifying of what our System-based strategies are; what they should be. The entire discussion is so the practitioners can grasp what is the need and gap, have increased knowledge and turn that knowledge into a better strategy (i.e., clinical competence) to approach the patient.

37. Paperless in 2013 Included in your handout are instructions on how to electronically submit session documentation. One PDF Excel of attendees

38. Things Not Mentioned Even Yet But Should Be o AWRC is a zero cost center. Meaning AWRC does not receive any operational funds from BHCS. o AWRC does NOT have any budgeted funds for CME educational interventions. o AWRC charges a fee. o The originating entity/department is responsible to cover session related expenses. o AWRC will assist in soliciting grant funding but cannot accept the financial responsibility of any educational initiative.

39. The Most Often Asked Questions o How do I get a record of my CME credit? www.CMEBaylor.orgwww.CMEBaylor.org – select the request a transcript link o AWRC already approved a CME presented in ABC location, we want to present it again in XYZ location. Since it is already approved, we do not have to do anything, correct? Well, yes you do. o Is it okay for the representative from DRUGS4U Pharmaceutical Company to bring food to our RSS? No, according to the Standards for Commercial Support.

40. EMBER

41. CAMDEN